Health

After winning election, California’s AG turns to investigating hospital algorithms for racial bias


SACRAMENTO, Calif. — California Attorney General Rob Bonta won the November 8 election, demonstrating his progressive record on reproductive rights, gun control, and social justice reform. In mapping out his roadmap for the next four years, the 50-year-old Democrat wants to target racism in healthcare, including through an inquiry of software programs and decision-making tools used by hospitals to treat patients.

Bonta, the first Filipino-American to serve as the state’s top prosecutor, asked 30 hospital executives in August for a list of commercial software programs their facility uses. used to support clinical decisions, schedule operating rooms, and guide billing practices. In return, he give them the secret. His goal, Bonta told KHN, is to identify algorithms that can direct more attention and resources to white patients than minorities, increasing racial disparities in ability. access, quality and outcomes of health care.

“Unequal access to our healthcare system needs to be fought for and reversed, not continued and pervasive, and algorithms are capable of that,” Bonta said.

It is too early to know what Bonta will find and his office will not name the hospitals involved. The California Hospital Association said in a statement that such bias “has absolutely no place in the medical treatment provided to any patient in any care facility,” and declined to comment. further discussion.

Backers have high hopes for what Bonta will find – and in the next four years. “We expect to see a lot more from him this entire term,” said Ron Coleman Baeza, executive director of policy for the California Interethnic Health Network. “There is still much work to be done.”

Last year, Governor Gavin Newsom appointed Bonta as attorney general after Xavier Becerra left the position to join the Biden administration as secretary of the US Department of Health and Human Services. In the November 8 election that won him his first full term, Bonta faced Republican challenger Nathan Hochman, a former federal prosecutor. who is active? on prosecuting violent criminals and getting the lethal synthetic drug fentanyl off the streets. By contrast, Bonta advocates for gun control and the decriminalization of drug crimes at a lower level, and in January advised law enforcement officials to do not prosecute women for murder during fetal death, even if their drug use contributed to the death.

In Unofficial resultsBonta got about 59% of the vote statewide, compared with Hochman’s 41%.

Bonta, formerly a state legislator representing the East Bay, will be eligible to run for a second full term, which could allow him to serve for nearly 10 years.

His wife, Democrat member of Congress Mia Bonta, is one of the government officials discuss their abortion experience after a leaked draft of the US Supreme Court’s comments published in May revealed that the justices would likely repeal Roe sues Wade. After they did, the attorney general threatened legal action against local jurisdictions that have attempted to impose abortion bans.

Bonta calls health care the right of all Californians and says he wants to help people of color and low-income communities gain more access to doctors and treatments, as well as care. better. “It is something that I have actively worked on as an elected official throughout my career and even before that,” said Bonta, whose father helped organize health clinics for people with disabilities. farmers in the Central Valley, said.

But health equity remains an elusive target, even as it has become a buzzword among advocates, researchers, politicians, and healthcare executives. And as with most aspects of the state’s massive health care system, progress has been slow.

For example, the Newsom administration will require managed care plans to sign new Medicaid contracts to hire an equity director and commit to reduce health disparities, including in child and maternal care. The state Medicaid program, called Medi-Cal, serves nearly 15 million VND people — most of them people of color. But those changes won’t come until 2024 at the earliest.

State legislators are also trying to reduce racial segregation through legislation. For example, in 2019 they passed a mandatory law implicit bias training for health care providers serving pregnant women. black women are three times are as likely to die of childbirth as white women.

In recent years, researchers start warning That racism has been incorporated into the diagnostic algorithms that doctors use to guide their treatment decisions. A model predicts a lower success rate for normal delivery in black and Hispanic women who had had a cesarean section compared with white women, but regardless of the patient’s marital status and insurance type, both of which can affect rates success rate of vaginal birth. Another approach, used by urologists, assigns Black patients to the emergency room with “ripple pain.” less likely kidney stones than non-Black patients — although the software developers couldn’t explain why.

Some researchers have likened such medical algorithms to risk assessment tools used in the criminal justice system, which could lead to higher bail amounts and longer prison sentences. for Black defendants. “If the underlying data reflect racist social constructs, their use in predictive tools will introduce racism into practice and policy.” They write in the New England Journal of Medicine 2020.

Bonta is seeking the cooperation of the hospital industry in its algorithmic investigation by treating racial and ethnic disparities as injustices that require intervention. He said he believes his investigation is the first of its kind and that it falls under the California Department of Justice’s responsibility to protect civil rights and consumers. “We have a lot of in-depth knowledge,” he said of his 4,500-employee company.

Coleman Baeza and other advocates for consumer healthcare said the attorney general should also oversee nonprofit hospital mergers to ensure that healthcare facilities don’t reduce beds in communities. underserved and cracking down on exorbitant medical lending, especially in dental care.

“They violate existing consumer protections and that is entirely within AG’s jurisdiction,” said Linda Nguy, senior policy advocate at the Western Center for Poverty and Law.

Dang urges Bonta to pursue underperforming health plans when they don’t contract with enough providers so patients can get appointments on time, even though the California Department of Managed Health Care is the governing body. the state’s primary health insurance agent.

“During the covid era, health plans were basically halted when it came to reporting on their timely accessibility. But that pause is over and plans must meet these requirements,” Nguyen said. “He can request that usage data.”

Bonta remains cautious on a particular issue related to race.

His office facilitated the California compensation task force, which issued nearly Preliminary report 500 pages This year, black Californians have shorter life expectancies and poorer health conditions than other groups. In surveys of hospitals across the country, Black patients with heart disease “received longer, cheaper and more economical treatment” than white patients, the report said.

The task force could propose cash compensation to black Californians who could establish ties with enslaved ancestors, but Bonta did not endorse that plan. The final report is due in July.

“If we can move the needle, we should,” says Bonta. “There are a bunch of different possible solutions, paths to get there.”

This story is produced by KHNpublish California Health Linean editorially independent service of California Health Care Foundation.

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